Document Detail

Postmeningitis subdural fluid collection in infants: changing pattern and indications for surgery.
MedLine Citation:
PMID:  16776372     Owner:  NLM     Status:  MEDLINE    
OBJECT: Postmeningitis subdural fluid collection (PMSFC) is a classic complication of bacterial meningitis in infants. When the diagnosis was based solely on subdural puncture (SDP), its incidence was estimated to be as high as one half of the cases of meningitis, with Haemophilus influenzae as the most common causative bacterium. Knowledge concerning the diagnostic and bacteriological characteristics of PMSFC has expanded greatly since the introduction of computerized imaging and the use of the anti-H. influenzae vaccine; however, in no recent study have the authors reappraised this clinical entity with regard to diagnosis, bacteriology, and indications for surgery. METHODS: The authors reviewed their cases of PMSFC in infants in which a diagnosis was made based on computerized tomography findings and confirmed with SDP. They treated PMSFC using placement of a subdural drain whenever the collection was either clinically eloquent or exerted a mass effect on the brain. In the 26 years preceding the study, the authors had treated 29 patients younger than 16 months of age for PMSFC. Eight patients required SDP only, 20 underwent surgical drainage, and five required craniotomy. In six cases, the fluid was grossly purulent; in the others, it was clear, xanthochromatic, or hemorrhagic. Cultures were positive for Streptococcus pneumoniae in only two cases. Although H. influenzae was the most common bacterium at the beginning of the series, Neisseria meningitidis has become more prevalent since vaccination against the former became widespread. Based on their data the authors estimate that 5% of N. meningitidis infections in infants are complicated by a significant PMSFC. CONCLUSIONS: At present, PMSFCs are most often caused by N. meningitidis. Temporary surgical drain placement is advised for all cases in which a significant mass effect is apparent on imaging.
Matrhieu Vinchon; Sylvie Joriot; Patrice Jissendi-Tchofo; Patrick Dhellemmes
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  104     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-16     Completed Date:  2006-07-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  383-7     Citation Subset:  AIM; IM    
Department of Pediatric Neurosurgery, CHRU de Lille, France.
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MeSH Terms
Gram-Negative Bacterial Infections / complications*
Infant, Newborn
Magnetic Resonance Imaging
Meningitis, Bacterial / complications*
Patient Selection
Retrospective Studies
Spinal Puncture
Subdural Effusion / diagnosis*,  microbiology,  surgery*
Tomography, X-Ray Computed
Treatment Outcome

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